Provider Demographics
NPI:1083981278
Name:BRINNER, ASHLEY (MSW)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:BRINNER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 S KICKAPOO ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:IL
Mailing Address - Zip Code:62656-2816
Mailing Address - Country:US
Mailing Address - Phone:217-828-0126
Mailing Address - Fax:
Practice Address - Street 1:418 S KICKAPOO ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:IL
Practice Address - Zip Code:62656-2816
Practice Address - Country:US
Practice Address - Phone:217-828-0126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$OtherSOCIAL SECURITY NUMBER